A Scoping Review of Intensive Interventions for Emotionally Based School Avoidance

Background: A significant proportion of children and adolescents with emotionally based school avoidance (EBSA) will not respond to evidence-based outpatient interventions. In such contexts, the role for intensive interventions has been recognised, most notably as the fourth tier of Kearney and Gracyzk’s multi-tiered system of supports framework for school attendance problems. Yet few attempts have been made to systematically examine such interventions, leaving stakeholders with insufficient data to guide decision-making about when, why, and for whom intensive interventions are indicated. Objective: To promote treatment of severe EBSA, this scoping review maps and characterises the literature on intensive interventions for EBSA in terms of (i) their structure, setting and underlying philosophy of change, (ii) completeness of intervention reporting, and (iii) robustness of study design and outcome reporting. Method: A systematic search of online databases identified peer-reviewed and grey-literature publications describing intensive interventions for EBSA published between 2000 and 2025. Titles and abstracts of 1,760 records were screened, with 64 full texts reviewed and 22 articles describing 19 distinct studies included. Data were charted using an a-priori coding manual. Intervention characteristics were mapped using an abbreviated eight-item TIDieR checklist covering setting, structure, modality, sample severity, theoretical foundation, and philosophy of change. Clarity and interpretability of study design and outcome reporting were summarised using a five-item Single-Group Reporting Robustness tool derived from STROBE and related frameworks (StaRI, SQUIRE).